Doctor Name: | RAYMOND KRESHA |
NPI Number: | 1932347432 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 11759 |
Business Practice Address: | 1136 Cougar Dr Canyon Lake, TX - 781333303 |
Business Phone Number: | 8309353771 |
Business Fax Number: | 8309353771 |
Mailing Address: | 1136 Cougar Dr, CANYON LAKE |
State: | TX |
Postal Code: | 781333303 |
Phone Number: | 8309353771 |
Fax Number: | 8309353771 |
NPI Enumeration Date: | 01/22/2009 |
NPI Last Update Date: | 10/19/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 11759 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |